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Nebraska rates for HCPCS L7402

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.88 / $283.88 / $283.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.88 / $283.88 / $334.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.25 / $430.37 / $434.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $489.67 / $489.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.35 / $489.67 / $755.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.11 / $482.60 / $2,083.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.48 / $263.43 / $370.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.23 / $489.67 / $616.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.15 / $578.70 / $1,008.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.48 / $222.08 / $348.40